Western Growers (Combined - Redacted)-Bates HW

7/27/2019 Western Growers (Combined - Redacted)-Bates HW

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From: Habit, Sandra (HHS/OCIIO)Sent: Thursday, November 04, 2010 3:09 PMTo: '[email protected]'Subject: Waiver Application - Western GrowersDear Mr. Resnick:

Thank you for your application for the Waiver of the Annual Limits Requirements of the PHS Act Section

2711. In order to complete your application, please provide the following information about the Western

Growers.

1. Indicate if there are essential benefit limits and the amount for the following categories :

Ambulatory: $Emergency (ER): $Hospitalization: $Laboratory: $Pediatric: $

Maternity: $Mental Health/Substance Abuse: $Rehabiliative: $Preventive: $Prescription (RX): $

2. (The premium amounts is the total cost to the employer and the employee)

Premium(current level)

Premium(renewal)

Premium(if $750,000annual limit wasapplied)

% increase if the$750,000 wasimplemented

EE

EE + Child (if

applicable orother appropriatetier)

EE + Spouse (if


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Sandra Habit

Quality Analyst

Office of Consumer Information and Insurance Oversight

301-492-4175

[email protected]

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly

disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed,

or copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent

of the law.
mailto:[email protected]:[email protected]


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From: Jason Resnick [[email protected]]Sent: Thursday, November 04, 2010 3:54 PMTo: Habit, Sandra (HHS/OCIIO)Subject: RE: Waiver Application - Western GrowersSandy:

Thank you very much for your email. I will forward it to the appropriate staff and get a response to you on or before this

Monday.

Regards,

Jason

Jason ResnickGeneral Counsel

Western Growers

17620 Fitch St., Irvine, CA 92614

v 949.885.2253 | f 949.809.6253

[email protected]

www.westerngrowers.org

This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (or authorized to receivemessages for the addressee), you may not use, copy, or disclose this message (or any information contained in it) to anyone. If you have

received this message in error, please advise the sender by reply e-mail and delete this message. Thank you.

From: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, November 04, 2010 12:09 PMTo: Jason Resnick

Subject: Waiver Application - Western Growers

Dear Mr. Resnick:
mailto:[email protected]://www.westerngrowers.org/http://www.westerngrowers.org/mailto:[email protected]


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EE + Child (ifapplicable orother appropriatetier)

EE + Spouse (ifapplicable orother appropriatetier)

Family (ifapplicable orother appropriate

tier)

3. Indicate if the plan is fully-insured plan or a self-insured plan.

4. Indicate if the plan is an individual or group policy.

5. How many employees are covered under each policy?

6. How many policies are under the umbrella of Western Growers?

Please provide this information by 5:00 pm, November 8, 2010. We look forward to receiving your completed

application. If you have any questions, please feel free to contact me at 301-492-4175.

Thank you,

Sandy Habit

Sandra Habit

Quality AnalystOffice of Consumer Information and Insurance Oversight

301-492-4175

[email protected]


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From: Habit, Sandra (HHS/OCIIO)Sent: Friday, November 05, 2010 10:35 AMTo: 'Jason Resnick'Cc: 'Jonathan D. Alexander'Subject: RE: Waiver Application - Western Growers

Hi Jason,

Unfortunately 12:00 pm ET will not work today as I have a meeting. Would 2:00 pm ET be acceptable?

Thanks,

Sandy

From: Jason Resnick [mailto:[email protected]]

Sent: Thursday, November 04, 2010 6:14 PMTo: Habit, Sandra (HHS/OCIIO)Cc: Jonathan D. AlexanderSubject: RE: Waiver Application - Western Growers

Hi Sandy:

I, and a couple members of our staff, would like to speak with you to get some additional clarification in connection with the

questions you pose below and to go over aspects of our waiver application. Would you be available by phone at 9:00 a.m.PT/12:00 p.m. ET? If that time is not convenient, please let me know the next available time. Thank you very much.

Regards.

Jason

Jason Resnick

General Counsel

Western Growers


v 949.885.2253 | f 949.809.6253

j i k@


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Ambulatory: $Emergency (ER): $Hospitalization: $Laboratory: $Pediatric: $

Maternity: $Mental Health/Substance Abuse: $Rehabiliative: $Preventive: $Prescription (RX): $

2. (The premium amounts is the total cost to the employer and the employee)

Premium(current level)

Premium(renewal)

Premium(if $750,000annual limit wasapplied)

% increase if the$750,000 wasimplemented

EE


EE + Spouse (if


Family (ifapplicable orother appropriatetier)

3. Indicate if the plan is fully-insured plan or a self-insured plan.4. Indicate if the plan is an individual or group policy.



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applied)

EE


EE + Spouse (ifapplicable orother appropriatetier)

Family (if


3. Indicate if the plan is fully-insured plan or a self-insured plan.

4. Indicate if the plan is an individual or group policy.


6. How many policies are under the umbrella of Western Growers?

Please provide this information by 5:00 pm, November 8, 2010. We look forward to receiving your completed

application. If you have any questions, please feel free to contact me at 301-492-4175.

Thank you,

Sandy Habit

Sandra Habit

Quality Analyst

Office of Consumer Information and Insurance Oversight


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From: Jason Resnick [[email protected]]Sent: Friday, November 05, 2010 6:08 PMTo: Habit, Sandra (HHS/OCIIO)Cc: Jonathan D. AlexanderSubject: Western Growers Assurance Trust

Importance: High

Attachments: Spreadsheet for HHS (2) (2).xlsxSandy,

As discussed, attached is the additional information you requested (Premium at renewal and Premium if $750K annual limit

was applied) in support of WGATs waiver application. Should you have any further questions, please do not hesitate to

contact me. Thank you again for your attention to our application.

Regards,

Jason

Jason Resnick

General Counsel

Western Growers17620 Fitch St., Irvine, CA 92614

v 949.885.2253 | f 949.809.6253

[email protected]


This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (or authorized to receive

messages for the addressee), you may not use, copy, or disclose this message (or any information contained in it) to anyone. If you have

received this message in error, please advise the sender by reply e-mail and delete this message. Thank you.
mailto:[email protected]://www.westerngrowers.org/http://www.westerngrowers.org/mailto:[email protected]


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From: Jonathan D. Alexander [[email protected]]Sent: Wednesday, November 03, 2010 2:57 PMTo: HHS HealthInsurance (HHS)Cc: Jason ResnickSubject: Waiver

Attachments: Part.3.Waiver 2010 cont- Tab 26-35 Exh B C.pdf; Part.2.Waiver 2010 cont-Tab 11-25.pdf;Part.1.Waiver Ltr 2010 Exh A Tab 1-10.pdfDear Mr. Mayhew,

I am counsel for Western Growers Assurance Trust (WGAT) and am writing to you today to provide an additional copy of

WGATs waiver application. On September 29, 2010, WGAT sent its waiver application to your office via UPS. At the same

time a courtesy copy was sent to Herb Schultz, the Region 9 Director of the Department of Health and Human Services, which

was received on 9/30/2010. However, it appears that our package was not delivered to you. We have been unable to verify

through UPS that our waiver application was actually received by your office.

For these reasons, we are sending a duplicate submission to you by email and will be sending another hard copy by UPS. In

light of the fact that we sent WGATs application on 9/29/2010 and it may not have been received, we would greatly

appreciate anything you can do to expedite review of this application. The attachments hereto, Part 1-3, include WGATs

waiver application letter, attestation, and relevant supporting documentation.

In the event that you did receive the original application, can you please verify this and contact me at your earliest

convenience. Thank you.

Very truly yours,

Jon D. Alexander, Esq.Compliance Counsel

17620 Fitch St.

I i CA 92614


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From: Habit, Sandra (HHS/OCIIO)Sent: Friday, November 12, 2010 3:18 PMTo: 'Jason Resnick'Subject: RE: Western GrowersHi Jason,

I had your application moved to the top of the pile so leadership reviewed it yesterday. My guess is you should receive a response

by Monday. I apologize that it could not be done any sooner.

Have a good weekend.

Sandy

From: Jason Resnick [mailto:[email protected]]Sent: Friday, November 12, 2010 2:38 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Western GrowersImportance: High

Hi Sandy:

Happy Friday! I just wanted to check in with you on the status of our waiver application. Is there any chance we will be able

to report the result of our wavier application when the Board of Directors meets this Monday for our Annual Convention?

Best,

Jason

Jason Resnick

General Counsel

Western Growers


v 949 885 2253 | f 949 809 6253


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From: Botwinick, Alexandra (HHS/OCIIO)Sent: Monday, November 15, 2010 3:46 PMTo: '[email protected]'Subject: Waiver of the Annual Limits Requirements of PHS Act Section 2711

Importance: High

Attachments: Updated Jan 1 Approval Letter .pdf; January 1 Denial Letter .pdf

Good Afternoon,

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

Section for Western Growers. HHS has reviewed your application and made its determination. Please see the

attached letters.

Please note:

The Approval Letter refers to the following plans:

Preferred

Choice

Affinity

Unison 1

U i 3


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Basic Plan 75

Basic Plan 25

Mexicali/San

Luis

Harvest Basic

Harvest

Imperial Gold

Harvest

Imperial Plus

Harvest

Imperial

Standard

Salud


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etter refers to the following plans:

Please confirm receipt of this letter by replying to this e-mail address with a copy to [email protected].

Please let me know if I can be of further assistance.

Sincerely,

Alexandra Botwinick

Office of Oversight

HHS/[email protected]


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From: Jonathan D. Alexander [[email protected]]Sent: Wednesday, November 24, 2010 8:04 PMTo: Mayhew, James A. (CMS/CPC)Cc: Habit, Sandra (HHS/OCIIO); Jason ResnickSubject: Western Growers Assurance Trust's Waiver Application Partial Denial

Attachments: WGAT.Denied.Minimed.Plans.xlsxDear Mr. Mayhew,

I represent Western Growers Assurance Trust (WGAT), a self-insured group health plan. WGAT recently submitted an

application for a waiver of the annual limits imposed by PHS Section 2711. In its application, WGAT sought a waiver for

several mini-med health benefit plans. The majority of the plans, 22 of 25, received a waiver. However, three plans were

denied a waiver.

The mini-med plans that were denied are virtually identical to those that received a waiver. In fact, the cost increase to those

plans that were denied is as much as % and the plans cover over participants.

I have attached an Excel spreadsheet that details the number of individuals participating per plan, the cost increase for each

and I can provide all of WGATs supporting documentation that we initially submitted if you so desire.

We respectfully request reconsideration of the denial of the three plans in question due the number of plan participants that

will lose access to health insurance, or in the alternative we request clarification regarding the rationale for denial of the

waiver of annual limits for these mini-med plans. Please contact me at your earliest convenience. I will be out of the office

for the remainder of the week returning on Monday, November 29, 2010. Thank you for your consideration of this matter.

Very truly yours,

Jon D. Alexander, Esq.

Western Growers Assurance Trust


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From: Andrews, Jane (HHS/OCIIO)Sent: Friday, January 28, 2011 4:11 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Did Western Growers ever appeal? If so, can you please send me appeal letter? tnx.

Jane W. Andrews

OCIIO

7501 Wisconsin Ave

Bethesda, MD 20814

301-492-4122 (desk)

202-536-6779 (Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:

This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmentuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.

Unauthorized disclosure may result in prosecution to the full extent of the law.


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From: Habit, Sandra (HHS/OCIIO)Sent: Monday, January 31, 2011 10:28 AMTo: Andrews, Jane (HHS/OCIIO)Subject: RE: Did Western Growers ever appeal? If so, can you please send me appeal letter? tnx.From what I know, Western Growers has not appealed.

Sandy

From: Andrews, Jane (HHS/OCIIO)Sent: Friday, January 28, 2011 4:11 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Did Western Growers ever appeal? If so, can you please send me appeal letter? tnx.

Jane W. Andrews

OCIIO

7501 Wisconsin Ave

Bethesda, MD 20814

301-492-4122 (desk)

202-536-6779 (Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:

This information has not been publicly disclosed and may be privileged and confidential. It is for internal governmentuse only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.

Unauthorized disclosure may result in prosecution to the full extent of the law.


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Jason Resnick

General Counsel

Western Growers


v 949.885.2253 | f 949.809.6253

[email protected]


This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (orauthorized to receive messages for the addressee), you may not use, copy, or disclose this message (or any informationcontained in it) to anyone. If you have received this message in error, please advise the sender by reply e-mail anddelete this message. Thank you.

From: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, November 04, 2010 12:09 PMTo: Jason ResnickSubject: Waiver Application - Western Growers


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EE + Child (if applicable or other appropriate tier)

EE + Spouse (if applicable or other appropriate tier)

Family (if applicable or other appropriate tier)


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From: Jason Resnick [[email protected]]Sent: Monday, November 15, 2010 3:10 PMTo: Habit, Sandra (HHS/OCIIO)Subject: Re: Western Growers

Sandy: Aloha from Western Growers Annual Convention in Hawaii! Do you have any news (official or unofficial) Ican report at our Board of Directors meeting today? I am so sorry to be a pest. I am being asked about the status of thewaiver app by my bosses literally every hour. I know you have done all you can to expedite the decision and keep meinformed, and I sincerely appreciate all you have done. Thank you very much for your patience.

Regards,Jason

----- Original Message -----From: Habit, Sandra (HHS/OCIIO) To: Jason ResnickSent: Fri Nov 12 12:17:39 2010Subject: RE: Western Growers

Hi Jason,

I had your application moved to the top of the pile so leadership reviewed it yesterday. My guess is you shouldreceive a response by Monday. I apologize that it could not be done any sooner.

Have a good weekend.

Sandy


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Best,

Jason

Jason Resnick

General Counsel

Western Growers


v 949.885.2253 | f 949.809.6253

[email protected]


This e-mail message contains information that may be confidential and privileged. Unless you are the addressee (orauthorized to receive messages for the addressee), you may not use, copy, or disclose this message (or any informationcontained in it) to anyone. If you have received this message in error, please advise the sender by reply e-mail and

delete this message. Thank you.


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From: Habit, Sandra (HHS/OCIIO)Sent: Thursday, December 02, 2010 10:34 AMTo: 'Jason Resnick'Cc: 'Jonathan D. Alexander'Subject: RE: Western Growers

Attachments: January 1 Denial Letter .pdf; Updated Jan 1 Approval Letter.pdf

Hi Jason,

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section forWestern Growers. HHS has reviewed your application and made its determination. Please see the attached letters.

Please note-The approval letter refers to the following plans:Western Preferred: $ K, $ K, $ K, $ K, $ K Newport 2000: $ K, $ K, $ K, $ K, $ K PreferredChoice Affinity Unis 1 Unison ursery PPO rsery Indemnity Ce He h and Well CG oundationCGF La Pisca Basic Plan 75 Basic Plan 25 Mexicali/San Luis Harvest Basic Harvest Imperial Gold Harvest ImperialPlus Harvest Imperial Standard Salud Salud II Plan 22 Plan 24 Harvest Comprehensive Los Amigos

e following plans:

Please confirm receipt of this letter by replying to this email address with a copy to [email protected]. Pleaselet me know if I can be of further assistance.

Thank you,Sandy


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From: Jason Resnick [[email protected]]Sent: Thursday, December 02, 2010 12:01 PMTo: Habit, Sandra (HHS/OCIIO)Cc: Jonathan D. AlexanderSubject: RE: Western Growers

Hi Sandy. Thank you very much for your prompt reply to our request for clarification.

Regards,

Jason ResnickGeneral CounselWestern Growers

17620 Fitch St., Irvine, CA 92614v 949.885.2253 | f [email protected]

This e-mail message contains information that may be confidential and privileged. Unless you are the addressee(or authorized to receive messages for the addressee), you may not use, copy, or disclose this message (or anyinformation contained in it) to anyone. If you have received this message in error, please advise the sender by reply e-

mail and delete this message. Thank you.

-----Original Message-----From: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]Sent: Thursday, December 02, 2010 7:34 AMTo: Jason Resnick

Cc: Jonathan D. AlexanderSubject: RE: Western Growers

Hi Jason


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Thank you,Sandy


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CGF Foundation

CGF La Pisca

Basic Plan 75

Basic Plan 25

Mexicali/San Luis

Harvest Basic

Harvest Imperial Gold

Harvest Imperial Plus

Harvest Imperial Standard

Salud

Salud II


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Pages 42 through 58 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

W Growers:000042


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Pages 59 through 126 redacted for the following reasons:

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Exemption 4

W G 000043

Western Growers (Combined - Redacted)-Bates HW

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